The EMR and Physician Burnout

Posted by Dan Mazanec, MD on Feb 16, 2016 1:02:25 PM

Less face time with patients

Less free time

Less personal satisfaction with practice

“After we get the kids to bed, I spend 2 or 3 hours at night finishing my charts.” “I’ve become a glorified data entry clerk.” “Is this really meaningful use?” During the last several years, I’ve heard these phrases from many of my colleagues in clinical practice, almost irrespective of their specialty. Dissatisfaction with the current state of the electronic medical record (EMR) is now widely recognized as an important contributor to physician “burnout.”

Burnout includes several dimensions including loss of enthusiasm for work, increased feeling of cynicism, and a feeling of being more callous with co-workers. Beyond purely personal concerns, burnout has broader societal impact by potentially reducing the quality of care and, with premature physician retirement, reducing access to medical services.

A recent (2015) Medscape survey reported 46% of all physicians were experiencing burnout. 3 of the top 4 reasons were related to the EMR:

Too many bureaucratic tasks

Too many hours at work

Increasing computerization

A 2014 survey of more than 400 practicing internists by the American College of Physicians found writing a note took more time in the EMR for 64% of respondents and the resultant loss of “free time” attributed to the EMR approached one hour daily. (JAMA Inter Med 2014; 174: 1860-63) Multiplied over the typical physician’s 7 day, 60-70 hour work week, this loss represents a major hit to productivity and quality of life. Of note, 70% of the doctors felt that the EMR decreased face time with patients, likely affecting both personal and patient satisfaction.

In a recent publication entitled “10 bold steps to prevent burnout in general internal medicine,” Linzer identified “decrease stress from electronic health records” as a key strategy to deal with the growing problem of physician burnout. (Jour Gen Int Med 2014;29:18-20) While this is a laudable goal, it will require re-inventing the EMR using currently available technology not found in many “dinosaur-era” EMR systems. Achieving this will require physician involvement from day one in redesigning the EMR workflow in a clinically relevant and useful way.

Using current state-of-the-art technology to build user friendly interfaces must reduce the documentation workload and increase “free time.” Ultimately, reducing physician stress, i.e., burnout, with a vastly improved EMR experience will lead to a more satisfying encounter for both doctor and patient with an improved clinical outcome.

About Dan Mazanec, MD

Prior to joining Dorsata in 2016, Dan Mazanec, MD was the Associate Director of the Center for Spine Health at the Cleveland Clinic. Board certified in internal medicine and rheumatology, he has been a leader in the development of the emerging specialty of Spine Medicine. A frequent lecturer at international and national meetings, he has authored more than 70 book chapters and papers. He is an active member of the North American Spine Society with a particular focus on the development of evidence-based clinical guidelines as a member of the Clinical Guidelines Committee and the role of non- surgical care as chairman of the Rehabilitation Interventional Medical Spine Committee.
Dan led the development of the Cleveland Clinic Spine CarePath which merges evidence-informed clinical management of spine disorders with patient-entered clinical outcome data focusing on optimizing value. He was the clinical lead for technologic enablement of the CarePath in the EMR and the implementation of the Spine Carepath across the entire Cleveland Clinic Health System.